ECG Findings

Valvular Heart Disease

Mitral Stenosis
Mitral Regurgitation
Aortic Stenosis
Cardiomyopathies
Restricted Cardiomyopathy
Dilated Cardiomyopathy
Hypothropic Cardiomyopathy
Myocarditis
 Vetricular
depolarization

Ventricular
relaxation

Atrial
depolarization

denotes conduction through the atrial muscle,

atrioventricular node, and His-Purkinje system
 ECG (12-lead ECG )

Importance

• Assess cardiac rhythm

• Determine the presence of LV hypertrophy or a prior MIPresence or absence of Q waves
• To determine QRS width to ascertain whether the patient may benefit from resynchronization therapy

A normal ECG virtually excludes LV systolic dysfunction.

Valvular Heart Disease
Aortic Stenosis
Mitral Stenosis
Mitral Regurgitation
 Aortic Stenosis
 In most patients with severe AS there is LV
hypertrophy

a longer period is
required for spread Prolonging
With left- of electrical
the
ventricular activation from the

hypertrophy
endocardial to the
epicardial surfaces
intrinsicoi
(LVH) of the d
hypertrophied
myocardium deflection
duration (0.05 s) of the prolonged intrinsico
L S A
n
o i
n n i
g c n
t
e e e
r r
t v
e
t h n
i e t
m r
i
e l
*** left-bundle branch-block (LBBB) c
e u
i f l
Arrows indicate the
intraventricular
conduction delay
Pressure overload causes sustained delayed
repolarization of the left ventricle, producing
a negative ST segment and T wave in leads
with leftward orientation (i.e., V5-V6); this
condition is termed left ventricular strain
ST-segment
depression and
T-wave
inversion
 In advanced cases, ST-segment depression and
T-wave inversion (LV "strain") in standard
leads I and aVL and in the left precordial leads
are evident.
 However, there is no close correlation between
the ECG and the hemodynamic severity of
obstruction, and the absence of ECG signs of
LV hypertrophy does not exclude severe
obstruction
ST-segment
depression and T-
wave inversion (LV
"strain") in
standard leads I and
aVL and in the left
precordial leads are
evident
 Mitral Stenosis
 In MS and sinus rhythm, the P wave usually
suggests LA enlargement
increase in theincrease in the
volume of bloodresistance to
within the blood flow out of
chamber it

Cardiac-
chamber
enlargement
 The increase in blood volume causes dilation
of the chamber, and the increase in resistance
causes thickening of the myocardial wall of the
chamber (hypertrophy)
 The thinner-walled atrial chambers generally
respond to both of these overloads with
characteristic changes in the electrocardiogram
(ECG).
 It proceeds from the It proceeds from the
Right-atrial activation sinoatrial (SA) node in sinoatrial (SA) node in
begins first an inferior and anterior an inferior and anterior
direction direction

which has a positive direction in all leads except aVR

 It proceeds from high
in the interatrial produces the final
Left-atrial activation
septum in a left, deflection of the P
begins later
inferior, and wave
posterior direction

which is positive in long-axis lead

II but negative in short-axis lead
V1
 Therefore, RAE is characterized by an increase
in the initial deflection
I V1
I
 LAE by an increase in the final deflection of
the P wave
II V1
 It may become tall and peaked in lead II and
upright in lead V1 when severe pulmonary
hypertension or TS complicates MS and right
atrial (RA) enlargement occurs.
 The QRS complex is usually normal.
 However, with severe pulmonary hypertension,
right axis deviation and RV hypertrophy are
often present
Arrows indicate the
high-voltage biphasic
RS complexes

Left-atrial
enlargement
( I and V1)
 Mitral Regurgitation
 In patients with sinus rhythm, there is evidence
of LA enlargement, but RA enlargement also
may be present when pulmonary hypertension
is severe
 Chronic severe MR is generally associated
with AF (atrial fibrillation)
 In many patients there is no clear-cut ECG
evidence of enlargement of either ventricle
 In others, the signs of LV hypertrophy are
present
 A lead-V2 rhythm strip from a 64-year-old
man with severe mitral regurgitation

Arrows indicate the even longer and even

shorter preceding cycles for another normally
conducted beat than for the wide beat
CARDIOMYOPATHIES
Dilated Cardiomyopathy
Restrictive Cardiomyopathy
Hypertrophic Cardiomyopathy
 Hypertrophic Cardiomyopathy

 Shows low-voltage, nonspecific ST-T-wave

abnormalities and various arrhythmias
 A 12-lead ECG recording from a 29-year-old
asymptomatic man during a routine health evaluation

Arrows indicate the waveforms

most characteristic of
hypertrophic obstructive
cardiomyopathy, including the :
•prominent Q waves in
leads aVL and V6
•tall precordial R
waves in leads V2 to
V5
•increased terminal P-
wave negativity in lead
V1
 Dilated Cardiomyopathy
 Sinus tachycardia or atrial fibrillation,
ventricular arrhythmias, left atrial abnormality,
low voltage, diffuse nonspecific ST-T-wave
abnormalities, and sometimes intraventricular
and/or AV conduction defects
 Restrictve Cardiomyopathy
 ECG often shows low-voltage, nonspecific ST-
T-wave abnormalities and various arrhythmias
 MYOCARDITIS
 The clinical spectrum ranges from an
asymptomatic state, with the presence of
myocarditis inferred only by the finding of
transient electrocardiographic ST-T-wave
abnormalities, to a fulminant condition with
arrhythmias
 Diffuse T wave inversions; saddle-shaped ST-
segment elevations may be present (these are
also seen in pericarditis)
 Myocarditis

Arrows indicate the P waves

occurring without a fixed
relationship to the QRS